Introduction

Our team of staff, Board members and Pennsylvania Mental Health Consumers’ Association (PMHCA) members continue to effect positive change for people in recovery and in the delivery of recovery oriented mental health services.

We are an organization governed, managed, and staffed by people who identify as being on mental health recovery journeys. And together with our members, we are the only statewide group that represents the voices of people in mental health recovery. We very much appreciate the support given to our mission by PMHCA members.

PMHCA Team and Activities

Our hardworking staff is what makes all of this work happen.

Pat Madigan, Community Outreach Coordinator, continues to be involved with the Keystone Pride Recovery Initiative, assists with training and policy issues and works on the two SAMHSA grants, Recovery and Resiliency and Statewide Consumer Network.

Pat provides Leadership in Recovery presentations and is available to conduct Mental Health Advance Directive training. She was the primary staff to gather information for the Recovery Works! Summit and is involved in many ways with the work of both SAMHSA grants. Pat travels more than the rest of us combined and we thank her for her willingness to do that.

Technical assistance is provided by Pat to the four Community Support Plan regions. She promotes the concept of “nothing about us without us” through CSP and elsewhere. Local CSPs requested her assistance during this past year to get back on their feet and she put a lot of time and effort into those endeavors. Pat was presented with the Consumer Scholarship Award in memory of Rita Cisneros at this spring’s annual PA Psychiatric Rehabilitation Conference.

Tyler Eppley is our Fiscal Manager. He works with Kristal Plummer, bookkeeper/fiscal consultant, to keep track of all income and expenses. This past year we have had SAMHSA, CMS, Developmental Disabilities Council, OMHSAS and PCCD grants, all with unique budgets and reporting systems. Tyler maintains and submits all related fiscal reports. He also prepares budgets and budget narratives for grant renewals and new grant applications. We received a clean audit report (available on our web site) and hope to do the same this year. Tyler is also takes on many operations responsibilities.

Samantha Harkins is Administrative Assistant and helps with behavioral health navigation calls, finding mental health resources for people who need them. She has to be knowledgeable about all of our work because her assistance on them is essential. We count on her to take meeting minutes, conduct meeting planning and much more. She often assists Pat with particular outreach projects.

Ellen Schellenberger is a Health Insurance Navigator, experienced in navigating the ins and outs of the Health Insurance Marketplace and Medicaid. She attends outreach events, participates on many Rapid Response Teams, makes presentations and travels to communities to enroll people in insurance options. Some of the healthcare situations experienced by people are very complicated.

Liz Woodley coordinates implementation of our Statewide Consumer Network grant. She is sought after for forensic peer support trainings and presents them around the state. She keeps the trainings organized, working with Sam and the rest of us to plan venues, conduct registration, prepare materials, develop and enhance our curricula and do the training.

Deb Hodges Hull provides information and referral services as a Behavioral Health Navigator and is a certified Health Insurance Navigator. She is employed by MHAPA and housed at the PMHCA office. This year she became a part time, temporary employee of PMHCA to coordinate the CCBHC, as previously mentioned.

Garth Champaign works elsewhere full time and is a part time Health Insurance Navigator. His help in the York area and on weekends and evenings adds to our ability to provide the navigator services in central Pennsylvania.

Report on current year

We continue to function with just 30 percent of the state funding that we used to receive. In order to sustain PMHCA and its mission, we have applied for various grants and been successful with most of our applications. The grants and their work will be discussed later in this report.

Secretary Ted Dallas’ leadership at the Pennsylvania Department of Human Services made it possible for DHS to examine and revise old regulations in OMHSAS and other parts of DHS. PMHCA staff have participated on DHS licensing workgroups, including an assisted living regulations work group, and on OMHSAS Inpatient Regulatory workgroups. Each workgroup had consumer input in addition to that of PMHCA.

Pat Madigan has had a busy year with Community Support Programs. In addition to providing technical assistance to the regional Coordinators, she has assisted local CSPs to re-organize and again bring consumers the ability to represent themselves to the local and regional mental health offices.

Our work under the SAMHSA Recovery and Resiliency grant where we collaborate with PRO-A has enabled Pat and also Patti Baranowski, Recovery and Resiliency Coordinator for PRO-A, to reach out to the CSPs to continue discussions on mental health and addictions recovery that began at last year’s Recovery Works! Summit. They bring the feedback to the grant’s advisory committee and our staff to inform policy efforts and topics to be discussed at the second Summit, which will be held in Harrisburg on September 13, 2017.

Some scholarships are available to help people attend the Summit but we unfortunately cannot accept any more applications at this time. An attendee of last year’s summit said this on the PMHCA Facebook page:

The Recovery Works Summit 2016 was one of the best conferences I have ever attended. The keynote presentations were organized perfectly, the number of providers with tables was amazing and the knowledge available on the breakout sessions was nearly overwhelming. Plus, the hotel is lovely. I have already purchased my ticket and made my reservations for 2017. If Co-occurring Disorders are of interest to you the Recovery Works Summit is a MUST.

The state funding we received this year from OMHSAS is the same amount we have received for the previous three years. We will not know how much we will have for FY 2017-2018 until after the legislature passes a budget. Governor Wolf proposed holding the line on most human services, with increases for a few, such as more funding for waivers that serve those with intellectual disabilities. Under his proposal, community mental health would have stayed pretty steady. Under the House budget, voted on in May, there would be less funding for mental health and substance abuse disorder services: $5 million less for community mental health and also less money appropriated for Centers of Excellence, which are designed to help fight the opioid crisis. The PA Senate has not yet presented their version of the budget. We need to stay tuned to what is happening and to continue to educate our legislators about the importance of financial resources to the behavioral health field.

Collaboration with other organizations is still the best way to proceed when organizational resources are tight. We continue to work on funding and activities with the Mental Health Association in Pennsylvania (MHAPA). Samantha, Administrative Assistant, assists with some MHAPA tasks and we share office equipment and office space with MHAPA. It is easy to stay in touch since MHAPA rents the lower floor of the PMHCA building.

Our Navigator Consortium, funded by a grant from the Centers for Medicaid and Medicare Services of the U.S. Department of Health and Human Services, consists of PMHCA, MHAPA, Mental Health Association of Westmoreland County (MHAWC) and The Advocacy Alliance. We continue to provide Health Insurance Navigator services to people with behavioral health needs and to the community at large. We entered into this work because the Affordable Care Act (ACA) requires that all health plans in the Marketplace provide behavioral health care (mental health and drug and alcohol treatment) in addition to physical health care. Additionally, pre-existing conditions no longer disqualify people from getting insurance, as they did prior to enactment of the ACA, opening up insurance coverage for people who may have been disqualified due to mental health conditions.

It is important to note that the Open Enrollment period for the Health Insurance Marketplace will be shorter this year. It begins November 1, 2017 and ends December 15, 2017. This gives people just six weeks to enroll, compared to the previous enrollment periods of three months.

Medicaid Expansion, initiated by Governor Wolf in January 2015, has enabled over 715,000 individuals to obtain health insurance. Many use the insurance to meet their behavioral health needs. We are proud that our navigators and other staff have been part of helping people get this coverage.

Positive relationships have been developed with the PA Department of Labor and Industry (L&I) and the Department of Corrections (DOC) due to the navigator grant. Our work with the L&I Rapid Response Teams, which provides assistance to workers losing jobs through lay-offs has been a good way to reach people who are losing insurance and may be eligible for Medicaid/CHIIP and the Health Insurance Marketplace. Work with the DOC enables us to go to state prisons to explain insurance options that will be available for people upon their release to the community. We have also gone to community corrections centers in much of the state. Often Certified Peer Specialists who are incarcerated are part of the audience.

PMHCA is a member of the PA Mental Health Parity Coalition which tracks new proposals in the PA legislature designed to tighten parity requirements for insurers and to meet with the Insurance Commissioner.

Representative Thomas Murt worked with the coalition to introduce House Bill 440 that will strengthen the Insurance Department’s ability to enforce the federal parity law. Information is available from PMHCA. The bill has not yet come up for a vote. Current Congressional attempts to repeal the Affordable Care Act could harm the progress made for people by the federal Mental Health Parity and Addictions Equity act of 2004. In the interim, the Department of Insurance has updated their website information to better inform readers about parity. They are working on a detailed analysis of approved insurance plans to analyze whether they are meeting federal and state parity requirements.

An “Assisted Outpatient Treatment” bill, HB 1233, passed in the PA House of representatives and is now being looked at by the PA Senate. This bill has been promoted by “TAC”, the Treatment Advocacy Center, based in Virginia, with the help of a Pennsylvania lobbying firm. In collaboration with other advocates, we worked to add suggested language that would require specific kinds of treatment before AOT was imposed by the Courts but TAC did not accept the language, which had been written by Carol Horowitz at Disability Rights PA. We believe there are costs inherent in the bill’s implementation but the House Appropriations committee decided that the only costs would be for the Court. The bill does say that only available services can be ordered.

The Department of Human Services announced this spring that the civil unit of Norristown State Hospital will be closed and used only for people sent to Norristown by a court for their involvement in the criminal justice system. PMHCA is part of the Coalition for the Responsible Closure of the Norristown State Hospital Civil Unit. As with previous closures, we are working with other advocacy organizations to help assure that people leaving the civil unit are leaving with a Community Support Plan that will provide them with resources needed to help them return to, and remain in, their communities. Stakeholder meetings are being held and there are ongoing conversations with OMHSAS and Norristown staff.

In a letter sent by the coalition to OMHSAS on June 17, we requested the following:

That the state schedule a stakeholder meeting in September where counties in both the NSH and Wernersville State Hospital (WeSH) service areas come prepared to discuss their plans – specifically, identify the services and supports that will be developed, increased or enhanced and the projected number of individuals returning to communities from both NSH and WeSH. While we recognize that plans will be finalized based on the specific recommendations in the community support plans (CSPs), we believe that the counties have sufficient information to present details regarding what services and supports are needed and will be developed.

That the state develop a timeline by September that outlines an action plan with target dates. This plan should include actions such as projected dates for closing admissions, completion of CSPs and projected dates for operation of community programs.

Governor Wolf proposed in his state budget to merge or unify several parts of the government that provide health and human services related programs. This includes DHS, the Department of Health, Department of Aging and the Department of Drug and Alcohol Services. While acknowledging that this must be done responsibly, there are benefits that could come from pulling together these departments. In a letter to Secretary Dallas and the other Secretaries, we urged all of the department heads to seriously consider how consolidation will include people with mental illness. We cited possibilities:

Office of Developmental Programs, for example, could develop specific services for people of all ages who have both autism and mental illness. They could work more closely with current OMHSAS staff to develop community services for state hospital residents with these concurrent needs who are waiting for discharge and, of course, to prevent hospitalizations.

The coming together (again) of OMHSAS and DDAP presents an excellent opportunity to talk about how to collaboratively address the concurrent needs of people with both mental illness and substance use disorder. SAMHSA statistics state that only 7.4 percent of persons with both a mental and substance use disorder receive treatment for both conditions, with 55.8 percent receiving no treatment at all. Also, 25.7 percent of all adults with serious mental illness also have a substance use disorder. We asked: How does this new department plan to help these individuals, as well as the children and youth who have a need for early diagnosis and treatment?

Suicide and overdose deaths are often related. One person dies by suicide every five hours in Pennsylvania and it is the eleventh leading cause of death in the state. Pennsylvania’s suicide rate, as reported by the American Federation for Suicide Prevention in 2016, was 13.28/100,000 people compared to the national rate of 12.93/100,000. The combined departments should be able to work cooperatively on these issues and to reach more people in need.

A bill was introduced in the General Assembly in June, 2017, that would create the proposed unification. PMHCA will continue to provide input as the process evolves.

Grant Funding

Our grant funding this year includes the second year of our Substance Abuse and Mental Health (SAMHSA) Statewide Consumer Network grant. Liz Woodley continues at the Forensic Peer Support Coordinator. We enhanced our Peer Support within the Criminal Justice System curriculum and conducted trainings in several communities for a total of 110 individuals. The trauma informed care training developed this year was piloted in June at the Mental Health Association of Franklin/Fulton Counties with 17 participants and this one-day training will be offered throughout the next year after we complete training of trainers.

With short-term grants from OMHSAS, we were able to have Liz and other facilitators provide Veterans forensic peer support training in State Correctional Institutions. The 148 trainees at the SCIs were certified peer specialists who valued the opportunity to expand their education and to share some of their lived experience. Many of them have joined PMHCA and now know about our work. It is hoped that some of the people who received their peer specialist certification while in prison will be able to use the qualification to provide peer services in the communities when released.

The previously mentioned Recovery and Resiliency grant with PRO-A will end September 30, 2017. The SAMHSA grant project officer informed us that there will not be a third year of this grant. We were fortunate to receive the second year, since it began as a one year project. This grant has given us the opportunity to work collaboratively with PRO-A in addressing issues that impact those in mental health and substance abuse disorder recovery. We will do our best to continue the joint work after the grant ends.

We are in the second year of a three year Centers for Medicare and Medicaid Services grant and had provided the navigator services with 3 previous one-year grants. Our collaborative partnership allows us to cover the state in a way that PMHCA would be unable to without the other organizations. We assist approximately 900 to 1,000 people each year to enroll in the Health Insurance Marketplace and Medicaid, depending upon their eligibility. We also do outreach to many community and statewide resources through presentations, exhibit tables at job and health fairs, “May is Mental Health Month” events, Community Support Program meetings and numerous other venues around the state.

PMHCA had five years of funding from the PA Developmental Disabilities Council for the Stigma Project. The underlying concept that the Council wants to convey is that people who stigmatize others need to think again about how that stigma hurts and stereotypes the stigma victims. People with disabilities are not the cause of stigma. It is up to all of us and the broader community to think again about our attitudes toward “others” and those who are different. Much work has been done through social media, focus group meetings, a press conference and development of a video that can be used to stimulate discussion of stigma. There is a website www.letsthinkagain.org and a twitter campaign @letsthinkagain. The grant ends this month. We have encouraged the Council to find a way to continue the website and social media presence. The video is available for people to use in facilitated discussions about stigma and changing attitudes. www.letsthinkagain.org

Our state OMHSAS funding enables us to do the ongoing, day to day work of PMHCA, including our policy work through participation on state workgroups, education about mental health, fighting stigma, and our CSP work. Mental Health Advance Directives training also continues due to the state funds. Pat Madigan, Lynn Keltz and Sue Walther of MHAPA provided Advance Directive trainings this year and gave hundreds of booklets to organizations interested in providing them to their constituencies. We expect this MHAD work will occur in future years and would like to Pennsylvania to collaborate with other organizations to train more trainers when funding becomes available.

We continue to pursue our PMHCA goal of eliminating stigma against people with mental health needs through both the Stigma Project and “I’m the Evidence”, an anti-stigma campaign developed by consumers and funded through Mental Health Association in Pennsylvania. Pat Madigan, in particular, provides awards to communities and/or individuals through her work with Community Support Programs.

There are numerous opportunities for all of us to participate in collaborations and on work groups and committees that may enhance the quality of our public mental health system. A few are listed here.

We also do public presentations for large and small audiences on topics relevant to recovery oriented mental health and public health insurance.

With separate funds from OMHSAS, we assist the department with the Certified Community Behavioral Health Clinics (CCBHC) work that began with a SAMHSA planning grant award. Deb Hodges Hull works here part time to help OMHSAS coordinate their work. We are currently focused on helping the clinics obtain required training through Deb’s coordination and our role as fiduciary.

PMHCA’s Future

PMHCA’s 30th year begins in August. We have had ups and downs in membership, funding, staff, hopes and dreams in those thirty years. We would have liked to celebrate this anniversary by hosting a 30th annual conference but since that is not possible, we thank you all today for your support and membership. Some of you have been part of PMHCA since its inception. Some are new to our mission and our work.

Beginning in July, we will welcome two staff members of Youth Move Pennsylvania. Corey Ludden and Zack Karenchak come to us via a Systems of Care grant that has been administered by OMHSAS. We are looking forward to having youth and young adult involvement here and know that working with this group and their partners will make us stronger and will provide new opportunities to promote and support state policy that promotes recovery and resiliency.

The staff and Board of PMHCA thank all of our members and supporters. We must keep bringing our voices together to promote recovery, acceptance of mental illness as yet another condition of life, and successful life in the community for everyone. We need to make it clear wherever we go that recovery is possible!

Our belief in the importance and viability of consumer run organizations and services remain a primary motivation for our work.

The activities we undertake to fight stigma, educate people about mental health needs and provide individual and systems advocacy continue. With your support and hope, and your memberships and donations, we can keep moving forward together to promote recovery and overcome stigma. Please keep in touch!